Columbus, Georgia

Agenda Item # ________



Columbus Consolidated Government



Council Meeting



09/10/2002



Agenda Report # _______________







TO: Mayor and Council



SUBJECT: Department of Fire and Emergency Medical Services Ambulance

Billing Information



INITIATED BY: Finance Department

_________________________________________________________



Recommendation: Approve the resolution to modify the current Department of

Fire and Emergency Medical Services' ambulance service billing documentation to

meet Federal guidelines.



Background: The Department of Fire and Emergency Medical Services (EMS)

provides transportation of individuals experiencing health difficulties that

might be life threatening. The cost of this service is paid by Federal and

State Healthcare programs, private insurers, individuals, and (as last resort)

the Columbus Consolidated Government. Reimbursement for this service is based

on billing data and schedules provided to the third party payors. The billing

data and schedules provided by EMS must comply with established guidelines as

set forth by the third party payors. Historically, the billing guidelines and

schedules established by the Federal Medicare Program for the reimbursement of

ambulances services have served as a model for all other third party payors.

The Balanced Budget Act (BBA) of 1997 mandated the establishment of billing and

reimbursement guidelines for ambulance services. Section 4531 (b)(2) of the BBA

added a new section 1834 (1) to the Social Security Act that mandates

implementation of national guidelines for billing and reimbursement for

ambulance services furnished as a benefit under Medicare Part B.



Analysis: EMS needs to incorporate the most recent guidelines, schedules, and

billing documentation as outlined in the BBA in order to receive maximum

reimbursement for ambulance services provided. The addition of Section 1834 (1)

to the Social Security Act has created additional categories of levels of care

provided through ambulance services. These changes will be phased in over a

four (4) year period, with the first phase beginning in 2002. The new

guidelines require the categories for ground ambulance services to consist of

Basic Life Support (BLS), Basic Life Support (BLS)-Emergency, Advanced Life

Support Level 1 (ALS1), Advanced Life Support Level (ALS1) - Emergency, Advance

Life Support Level 2 (ALS2), and Specialty Care Transport (SCT). The Department

of Fire and Emergency Services presently use only Advance Life Support (ALS)

and Basic Life Support (BLS) categories. Since the Federal guidelines are to be

phased in over four (4) years, the approval of this resolution will eliminate

having to return to Council for every phase of implementation change. The

changes to the EMS billing documentation are necessitated by the current

reimbursement trends in healthcare requiring emergency medical services to be

more specific as to actual services rendered.



Financial Considerations: The incorporation of the mandated billing guidelines

and schedules will ensure maximum reimbursement for services rendered with an

estimated increase in ambulance revenue of $500,000 in FY'03. By incorporating

the guidelines, the probability of recoupment of payments by third party payors

for failure to meet billing criteria is reduced.



Legal Considerations: Federal and State regulations require a provider of

emergency medical services to bill for ambulance services based on the physical

condition of the patient and the category of life support services provided.

Failure to meet established billing criteria may result in a request by third

party payors for recoupment of benefits expended, criminal prosecution, and/or

termination of participation in the Federal and State healthcare programs.



Recommendations/ Actions: Approve the resolution to modify the current

Department of Fire and Emergency Medical Services' ambulance service billing

documentation to meet Federal guidelines.











A RESOLUTION

NO. ____________

A RESOLUTION AUTHORIZING THE DEPARTMENT OF FIRE AND EMERGENCY MEDICAL SERVICES

TO MODIFY AMBULANCE BILLING INFORMATION NECESSARY FOR COMPLIANCE WITH THE

FEDERAL BALANCED BUDGET ACT OF 1997.

WHEREAS, the Department of Fire and Emergency Medical Services respond only to

requests for emergency medical assistance received through the 911 Center and

charge an all inclusive fee based on type of service rendered and transport

mileage for this assistance.

WHEREAS, it is necessary to modify the current Department of Fire and Emergency

Medical Services' ambulance service billing information to be in accordance

with the Federal Balanced Budget Act (BBA) of 1997. Section 4531 (b)(2) of the

BBA added a new section 1834 (1) to the Social Security Act that mandates

implementation of a national billing/reimbursement schedule for ambulance

services furnished as a benefit under Medicare Part B.



NOW, THEREFORE, THE COUNCIL OF COLUMBUS, GEORGIA, HEREBY RESOLVES AS FOLLOWS:

The Department of Fire and Emergency Medical Services shall utilize accepted

billing and reimbursement schedules necessary for compliance with the

guidelines outlined in the Balanced Budget Act (BBA) of 1997.



Introduced at a regular meeting of the Council of Columbus, Georgia, held

the 10thday of September, 2002, and adopted at said meeting by the affirmative

vote of _____ members of said Council.



Councilor Allen voting __________.

Councilor Davis voting __________.

Councilor Henderson voting __________.

Councilor Hunter voting __________.

Councilor McDaniel voting __________.

Councilor Rodgers voting __________.

Councilor Smith voting __________.

Councilor Suber voting __________.

Councilor Turner Pugh voting __________.

Councilor Woodson voting __________.



______________________________ _____________________________

Tiny B. Washington, Clerk of Council Bobby G. Peters, Mayor